Are Tai Chi and Qigong Effective in the Treatment of Traumatic Brain Injury? A Systematic Review

Abstract

Background Traumatic brain injury (TBI) adversely affects both young and old and is a growing public health concern. Several recent trends in managing TBI, such as recommending sub-threshold aerobic activity, tailoring multi-modal treatment strategies, and studying the potential role of inflammation in those with persistent symptoms, all suggest that the physical and cognitive exercise of tai chi/qigong could be beneficial. Method The following databases were searched: MEDLINE, CINAHL Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Cochrane-based risk of bias assessments were conducted on all included trials. Quality of evidence was assessed using the grading of recommendation, assessment, development, and evaluation (GRADE) system. Results Three randomized controlled trials (RCTs) and two non-RCTs were assessed. Four trials used tai chi as the intervention and one trial used qigong. Primary and secondary outcome measures significantly varied amongst all trials. Certainty of evidence by the GRADE assessment was higher for the RCTs than the non-RCTs due primarily to lower risk of bias. All four tai chi trials showed a beneficial outcome for the tai chi group. For the RoB 2.0 scores, one tai chi RCT had a low risk of bias and a high level of certainty by GRADE; one had some concerns. For the ROBINS-I scores, one non-RCTs had a moderate risk of bias and the other a serious risk of bias. The one qigong trial had a low risk of bias and a moderate level of certainty by GRADE. Conclusion Considering the high level of certainty from one RCT and the beneficial effects found in all four trials on tai chi, there is a sufficient signal to merit conducting a multi-centre trial on tai chi for TBI that will increase statistical power and test tai chi against current trends in the management of TBI. Although promising, based on a single trial, the signal for qigong is insufficient at this time; another single centre RCT is indicated. Systematic Review Registration: PROSPERO [CRD42022364385]